Cost-Effectiveness of Frontline PARP Inhibitor Maintenance in Advanced Ovarian Cancer

April 21, 2020
Rafael Gonzalez, MD

Rafael Gonzalez, MD, fellow, Gynecologic Oncology, Duke University Medical Center, discussed unanswered questions about the cost-effectiveness of implementing frontline PARP inhibitor maintenance to all patients with advanced ovarian cancer, a topic of a recently released abstract from the 2020 Society of Gynecologic Oncology (SGO) Annual Meeting.

The idea of evaluating the cost-effectiveness of PARP inhibition in the frontline setting of advanced ovarian cancer was initially thought of prior to the release of the 3 clinical trials that demonstrated the efficacy of this strategy. Those studies include the phase III GOG-0218 study of bevacizumab (Avastin) monotherapy, the phase III SOLO-1 study of olaparib (Lynparza, NCT01844986), and the phase III PRIMA study of niraparib (Zejula, NCT02655016).

The overarching question was, is it cost-effective to treat all patients with advanced ovarian cancer, regardless of whether they harbor a BRCA1/2 mutation or have homologous recombination deficiency with PARP inhibitor maintenance following primary treatment.

In addition, there was a question around how much benefit would biomarker-negative patients need to derive to allow for the universal implementation of PARP inhibitor maintenance to be cost-effective.

The findings from the evaluation were that universal implementation of frontline PARP inhibitor maintenance is not cost-effective, but more focused strategies, such as only treating biomarker-positive patients, may be cost-effective.

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